In two lengthy phone interviews with Ars on Tuesday, Konopka said if she is reinstated by the state's medical board—at this point, a big if—she would be willing to learn how to use the Internet to comply with the state's new law for an online opioid monitoring program.

Konopka recently sued the New Hampshire Board of Medicine and appeared in court without an attorney last Friday. The board, which is being represented by the state's attorney general's office, has filed a motion to dismiss. The office argues, essentially, that because Konopka voluntarily agreed to relinquish her medical license after a series of investigations, there's no going back now.

In the agreement with the board, which Konopka signed on September 12, she voluntarily surrendered her license to settle pending allegations regarding her "record keeping, prescribing practices, and medical decision making." Those allegations stem from five separate complaints against her. Under the terms of the agreement, she could reapply to regain her license, but the burden would be on her to prove that she did no wrong.

Konopka denied any misconduct and asserted that she was under duress when she voluntarily surrendered her license. She underscored that she wants to continue practicing medicine but simply is not concerned with what she calls "electronic medicine," her term for the vast bureaucracy often associated with modern medical practices.

"I am getting the patients from the system, and I see how badly they are mistreated and misdiagnosed or not diagnosed at all," she said. "Therefore, I am not going to compromise patients' lives or health for the system. Because I am out of the system, it was almost like in Communism, you were like the enemy and you had to be destroyed."

However, her stance on the use of electronic health records and modern health information technology runs counter to that of major medical associations, including the American Medical Association and the American Academy of Family Physicians (AAFP). Both support the use and improvement of modern technology to assist doctors and improve care.

The AAFP "believes that every family physician should leverage health information technology, which includes electronic health records and related technologies needed to support the patient-centered medical home (PCMH)," the AAFP writes on its website. "These capabilities can support and enable optimal care coordination, continuity, and patient centeredness, resulting in safe, high-quality care and optimal health of patients, families, and communities."

In an e-mail to Ars, the AAFP noted that adoption of such technology, including but not limited to computers, is so widely accepted that it does not poll doctors on their use of such equipment.

“Fabricated”

In Konopka's telling, she is simply a local doctor who has been faithfully serving this small New England town of 4,000 people for well over two decades. She sees people under their medical insurance or will accept a $50 cash payment for those who do not have insurance.

"I've never had a problem with anything until now," she said.

Her troubles first began over three years ago, in October 2014, when there was a formal dispute over a seven-year-old female patient, referred to in court documents as "JM."

According to the attorney general's motion to dismiss, Konopka saw JM throughout most of her childhood, from age 18 months through age seven. JM suffered from asthma, and Konopka prescribed dexamethasone and albuterol, two medications commonly prescribed to treat asthma. The attorney general also noted Konopka "rarely noted Patient weight in the record when prescribing and generally left dosing up to Patient parents. Respondent also never tested Patient levels" and "did not attempt to treat Patient with a daily inhaled steroid."

Further, "on several occasions, Respondent prescribed Patient JM aspirin to help reduce fever and treat other ailments, even though aspirin is not recommended for children with asthma."

Konopka dismissed JM's complaints as "fabricated."

"They said I was using wrong medications, and they don't know the medications in the first place," she told Ars. "I was using medications approved by [Federal Drug Administration], and I am using these medications very successfully, and nobody died because they were claiming that I'm treating asthma in the wrong way, because I'm not prescribing inhalers, because inhalers are destroying the lungs. All my patients' children, they are growing out of asthma without COPD (Chronic Obstructive Pulmonary Disease)."

Konopka said she didn't prescribe inhalers because, in her view, they are more trouble than they're worth.

"I am not going to prescribe something that I think is dangerous or expensive," she said. "One inhaler costs $500."

According to Konopka, under her care, JM was "cured" after just three days.

Surrender

However, for whatever reason, JM's family apparently was not happy—it filed a formal complaint with the state medical board the following month. Konopka told Ars that JM's father worked for one of the larger medical facilities in the region, New London Hospital, and that the complaint was seemingly vindictive against her.

As a result of this episode, Konopka was formally reprimanded by the medical board in April 2017, and she agreed to undergo 14 hours of medical training as part of her settlement to continue practicing.

"For as long as she is licensed by this Board, Respondent must refer any diagnosed pediatric cardiac cases to a qualified pediatric cardiologist prior to providing any non-life sustaining treatment in such cases," the consent decree stated.

Following the April 2017 settlement, the New Hampshire Board of Medicine learned of four additional complaints that were being investigated by the board's Medical Review Subcommittee (MRSC). Court records do not reflect the precise nature of these new complaints. Konopka was unable or unwilling to explain precisely what these new disputes were about.

It was then that the medical board moved quickly: in September 2017, the board voted to discipline Dr. Konopka further. With the advice of an attorney assigned by her medical malpractice insurance, Michael Pignatelli, Konopka signed a "voluntary surrender of license" on September 12, 2017. Pignatelli did not respond to Ars' request for comment.

On September 28, Pignatelli asked the board to allow Konopka to keep practicing until the end of November. The request was seemingly denied.

Then, on October 11, Konopka sued the medical board without the help of an attorney. In a handwritten complaint, she told Merrimack County Superior Court Judge John Kissinger that "under multiple duress," she would "loose [sic] my medical license." Konopka asked the judge for an emergency ex parte (one-sided) hearing, but the judge denied her request.

In her civil complaint, she wrote that the medical board had "organized attacks from people unknown to me for [the] past three years forcing me to close my office."

By October 27, Senior Assistant Attorney General Lynmarie Cusack, representing the medical board, filed a motion to dismiss the case.

"Petitioner has not argued that she was prevented from exercising her rights in any extraordinary way or that she was misled about some fact," Cusack wrote. "To the contrary, it appears that Petitioner merely had a 'change of heart' or case of 'buyer's remorse.'"

Konopka said she could not afford an attorney to represent her, yet she maintained that people who have made accusations against her could be "exposing themselves to libel."

"I am not going to accept their abuse, period," she told Ars. "I am going to fight. If I win or lose, I am going to fight. For the sake of the patients, not for me. In my age, my colleagues in this country or in my country, they are retired or are in graves. And I can really go for quite many years working."

A change of heart

Konopka and Cusack faced off during a hearing on Friday, November 3. In an e-mail to Ars, Cusack characterized the hearing as "relatively brief."

"Dr. Konopka indicated that she did not want her patients to be without medical care and the [Affordable Care Act] didn't allow her patients to be picked up easily by other providers," Cusack wrote. "I indicated that the issue before the court was very narrow, and that was whether she could rescind her agreement that she entered voluntarily with the assistance of counsel, after having an opportunity to negotiate the terms of the agreement."

According to Cusack, Judge Kissinger said he would "take the matter under advisement." She added, "I hate to predict what judges will do, so I cannot say when he will rule or whether he was receptive."

For her part, Konopka was somewhat optimistic.

"I hope for the judge, he was very nice fellow—I hope that he would see my point of view, and if he does not, what can I do about it?" she told Ars.

However, Cusack also told Ars that a lawsuit like this is very unusual.

"I have never heard about or seen a doctor sue the board after they entered an agreement to forego discipline and then change their mind," she continued. "I am aware of two cases where a doctor has brought an injunction against the board attempting to stop a disciplinary action. So, no this is not a typical action."

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Cyrus Farivar
Cyrus is a Senior Tech Policy Reporter at Ars Technica, and is also a radio producer and author. His latest book, Habeas Data, about the legal cases over the last 50 years that have had an outsized impact on surveillance and privacy law in America, is due out in May 2018 from Melville House. He is based in Oakland, California. Emailcyrus.farivar@arstechnica.com//Twitter@cfarivar

190 Reader Comments

I'm not sure how I feel. I guess I think she should probably find something else that's important to her...or comply with the terms the board set for her.

She can get her license back (apparently) if she's able to prove to the board that she's in compliance.

I can understand her desire to protect her patients from expense but I'm a little troubled by the semi-conspiracy theorist vibe I'm getting.

I guess many doctors might consider cost when suggesting treatment strategies to their patients but it also comes across as a bit luddite-y: "You've got a broken leg there but modern casts are just too expensive aren't they? You'll be fine with this roll of tape and some sticks. Be sure to keep off it!"

It's pretty hard to judge without knowing the details of the additional complaints.

84 years old and has never even hired a part-timer to help with mandated medical billing and record-keeping? Yeah, I doubt that getting her license back, if at 84 anyone but druggies is well-served by her getting it back, will result in any change of behavior. People that old aren't known for changing mentalities rapidly.

I understand where she’s coming from, but by the sounds of it, she’s just too out of touch - a computer is essential for keeping up with best practice, new knowledge, along with medical reporting compliance

This reminds me of the baker we had in a small rural Wisconsin town where we have a cabin. He taught baking at a community college about an hour away. Everything he baked was some of the best I've ever had in the USA.

The problem was that his equipment was all from the 1950s. All solid functional equipment but the health inspector didn't know how or didn't want to inspect it and put him out of business.

Now there's just a grass lot where there was one of the best bakeries I've been to in the USA.

I'm not a general practitioner, and I don't work in the United States, though I do work in a hospital cutting holes into people. But from the little information available publicly, I do have a few issues with her attitude.

She views her medical practice as 'her vs. the system'. Now I know nothing of her situation, but a distressing proportion of the disasters and mistakes that I end up dealing with is the result of a gung-ho physician who is absolutely certain that they are correct, and damn the consensus. It's always the patient who loses and I hate having to deal with these situations.

Also, though I do every day curse the electronic health record and imaging software that I am forced to use; I would never go back to ye olde days. For one - no more horrible handwriting, but a single electronic record makes many things so much easier that I would rather deal with a crappy network connection and poor UI than go back to juggling three folders for one patient, each with conflicting information, while running around collecting x-rays and hunting down faxes from god knows which machine in the many admin and clinical offices.

If she is however routinely taking poor notes and not recording important details and getting necessary tests - well - that simply should not be happening.

it's not that hard to record patient notes for medical transcription. lots of doctors do it by dialling into a phone service. a medical transcriptionist working for a specialized company does the work for them (they often are paid by the word, not by the hour)

This reminds me of the baker we had in a small rural Wisconsin town where we have a cabin. He taught baking at a community college about an hour away. Everything he baked was some of the best I've ever had in the USA.

The problem was that his equipment was all from the 1950s. All solid functional equipment but the health inspector didn't know how or didn't want to inspect it and put him out of business.

Now there's just a grass lot where there was one of the best bakeries I've been to in the USA.

I am not a health inspector (IANAHI?), but shouldn't his job just be that the machinery can be used in a sanitary way, no matter when it's from?

In the case of this doctor, like others here said, I find it really hard to judge without more details. Is she a saint who helps people who couldn't otherwise afford healthcare and is just a bit oldfashioned with record keeping? Or is she a quack who uses the subpar record-keeping as an excuse for general lack of standards as a practitioner. Based on the two Ars articles, I can't tell.

It should be noted that she seems to be running a pill mill. She's got five allegations against her, four of which are not public due to her agreement. The only thing public besides the 7-year-old with asthma (who she just seems to imply she cured within three days), is that she does not check the Opioid database, and that many of her patients relied on her prescriptions for chronic pain..

Quote:

"It stinks, but you have to find a new doctor, and it's a rat race," said Stanley Wright, who saw Konopka the past year for chronic back pain. "The doctor I had before was over-medicating me, and she gives me a lot of herbal stuff and I was doing a lot better. Now, I'm back to being screwed. I don't know what to do."

Herbal medications don;t require a prescription, so she could declare herself a consultant and keep seeing this guy. The only reason he'd need her to have her license back would be if she was prescribing something not over-the-counter. Whatever it was is so secret that a) she daren't say it's name in public and b) she was willing to give up her license to avoid anyone else naming it in public.

This reminds me of the baker we had in a small rural Wisconsin town where we have a cabin. He taught baking at a community college about an hour away. Everything he baked was some of the best I've ever had in the USA.

The problem was that his equipment was all from the 1950s. All solid functional equipment but the health inspector didn't know how or didn't want to inspect it and put him out of business.

Now there's just a grass lot where there was one of the best bakeries I've been to in the USA.

I am not a health inspector (IANAHI?), but shouldn't his job just be that the machinery can be used in a sanitary way, no matter when it's from?

In the case of this doctor, like others here said, I find it really hard to judge without more details. Is she a saint who helps people who couldn't otherwise afford healthcare and is just a bit oldfashioned with record keeping? Or is she a quack who uses the subpar record-keeping as an excuse for general lack of standards as a practitioner. Based on the two Ars articles, I can't tell.

And whose fault is it that you can;t tell?

Because of the five complaints against her the only one in the record is the one involving the kid with asthma. She agreed to have her license suspended to keep the other four from going onto the public record.

If you check out the USA Today article it mentions that several patients came to the court hearing, and they all seem to be being treated for chronic pain.

The NH Medical Board is mostly MDs, so it's not like she got dinged by a bunch of people with no medical training.

"I am getting the patients from the system, and I see how badly they are mistreated and misdiagnosed or not diagnosed at all,"

I'm against The Man! Even if The Man is out to heal you!

Quote:

"Therefore, I am not going to compromise patients' lives or health for the system. Because I am out of the system, it was almost like in Communism, you were like the enemy and you had to be destroyed."

seriously WTF?!

Quote:

"I've never had a problem with anything until now,"

let me guess, she's not wearing seatbelts too?

Quote:

"organized attacks from people unknown to me for [the] past three years forcing me to close my office."

I have grandma that thinks everybody is against her too, including closest family.

I hope she looses. She won't change otherwise, not at this age, she'll become only more entrenched.

This reminds me of the baker we had in a small rural Wisconsin town where we have a cabin. He taught baking at a community college about an hour away. Everything he baked was some of the best I've ever had in the USA.

The problem was that his equipment was all from the 1950s. All solid functional equipment but the health inspector didn't know how or didn't want to inspect it and put him out of business.

Now there's just a grass lot where there was one of the best bakeries I've been to in the USA.

This sounds like you only got one (biased) side of the story. I'm betting the actual county records would tell a different one, or maybe it just wasn't profitable. Or his kids didn't want to take it over, etc. Small businesses fail constantly for hundreds of different reasons.

We cannot have doctors questioning the system. Politicians NOT doctors should be in control of our health systems. Every aspect of health care needs to be FIRST signed off by lawyers and politicians THE END.

Well, the politicians are 'the representation of the people' that should, in theory, be 'informed by medical professionals and scientists'...

This is why there are 'legal' requirements to practice as a 'Medical Doctor'.

With that said, I can see the argument against systems that aren't based in fact or science and people that want to fight them.

A lot of what I learned in medical school has been superseded, and I only qualified 11 years ago. It's not just medical knowledge though, it's processes, skills, ethics, working practices. The pace of change is rapid, and rightly so - we learn new stuff, and better ways of doing things, and we have to keep up. Science, right?

I question whether someone can even be a competent doctor today without computer skills. You don't need to be a sysadmin but you do need to be able to record, access and process information.

In fact, information/knowledge isn't what doctors have that makes them useful any more, in contrast with the good ol' days. You can google pretty much any medical fact you want to. It's the interpretation and application of that knowledge (and separating out the nonsense) that makes us somewhat worth having around, at least for the time being until machines make us redundant.

If your processes are from the 1960s and your way of keeping up is paper-only, I can't imagine how you can have sufficient up-to-date knowledge to do a good job as a clinician.

She should retire from the US and go work at a medical mission in a developing country like Haiti (if they'd have her); her skills would be much better served there, plus there'd be a lot less paper work. Of course, she'd be working for free and for charity, not $50 a shot (which I find shocking from a socialized medicine perspective).

Also, $500USD for asthma medication??? That's crazy. I have severe asthma and have never come close to spending that much on a single inhaler, that's inhuman! I'm living in a developing country, a Ventolin inhaler here (branded made in France) costs 50 cents.

We cannot have doctors questioning the system. Politicians NOT doctors should be in control of our health systems. Every aspect of health care needs to be FIRST signed off by lawyers and politicians THE END.

Congratulations.... that is the most concentrated stupid I have read all week. I'm afraid I have no trophies to award you though. This administration has sapped all my stores since January. When I get the new stock in, I'll give you your trophy though.

Doctors surgeries absolutely should be encouraged to use electronic records. it makes transfering them easier, you can run reports on em so they can pick up trends, and perhaps string together long standing symptoms to identify latent issues. It can also help prevent incompatible medications being prescribed.

...But should a Doctor be refused permission to practice for refusing to use this tool?... I'm hesitant to get to that stage. I am not convinced that not using electronic records is risky enough or dangerous enough to get over that hump.

If the doctor can comply with all of the usual requirements but use Dead Tree instead of a computer, then I would be inclined to let them practice.

She should retire from the US and go work at a medical mission in a developing country like Haiti (if they'd have her); her skills would be much better served there, plus there'd be a lot less paper work. Of course, she'd be working for free and for charity, not $50 a shot (which I find shocking from a socialized medicine perspective).

Also, $500USD for asthma medication??? That's crazy. I have severe asthma and have never come close to spending that much on a single inhaler, that's inhuman! I'm living in a developing country, a Ventolin inhaler here (branded made in France) costs 50 cents.

Actually, I can name two right now (inhaled steroids) that are over $500 per inhaler.Xolair ($500 - $2000 per month), and Advair 50/500 ($400 per month [2014, it's more now])

How much else has she not bothered with? Is she keeping up with the latest medical research? Is she following changes in standards of care?

Would you prefer to go to a doctor in 1965, or a doctor in 2015?

Well, maybe this is a nostalgic view of the past, but the 1965's doctor is probably closer to my family, is more of a family-confidant, and as they (and their clinic partners) have likely been looking after me since the day I was born, they probably have an innate view of my total health picture. They understand I have to work and are happy to stay a little later so I can pop by the clinic, or swing through on lunch.

The 2015 doctor has 10 minutes for me before I'm over the scheduled time, and surgery hours are surgery hours - strictly 9-5. Go call the health information line if you get sick at 5:05.

As a doctor I find the fact that she gave aspirin to a asthmatic kid utterly shocking . Aspirin is strongly contraindicated in asthmatics and infact aspirin itself can trigger an attack even without the original irritant www()en.wikipedia()org/wiki/Aspirin-induced_asthma

Even apart from that using aspirin to treat fever of uncertain origin in kids is not advised due to its association with Reye's syndrome . There are much safer and simpler(cheaper) drugs available even if cost was an issue .

Finally giving systemic corticosteroids (oral or injection ) dexamethasone in a asthmatic is very questionable . Steroids have a long list of side effects especially in kids and should be last resort in severe intractable asthma . Inhaled drugs are simply much much safer . Her claims of inhaler causing lung disease is ludicrous to the point of hilarity . Cost may be an issue but there are cheaper alternatives to inhalers if she had troubled to find out .

(yes , I was so pissed off at the utterly laughable medical practices that I signed up to rant here)

1. I have asthma. You are never "healed". The only thing you can do is treat the symptoms. The albuterol is only in case of an emergency to open up the lungs and no way a long-term treatment. Not using some form of Inhalator with steroids (as much as that sucks) which suppresses the immune reaction which causes issues in the first place is simply stupid and dangerous. Doing this in any other form than an inhalator means that you must use far higher doses and you are hitting the whole body instead targeting the one spot where you actually need it.To treat an asthmatic child with Asperin is simply idiotic. While it doesn't affect all, risks are still high that one can induce a bronchospasm. Combine this with the not treating the asthma effectively and that is one giant WTF.

2. As computers integrate more and more into society, computer literacy moves from "optional" to "required" to interface with society. One can debate about how much, but there is a reason why we teach reading and writing in the first grade. Computers will be right up there at some point. Until then, I expect those people who hold jobs which require such knowledge to acquire it on there own. I have no sympathies what so ever.

She should retire from the US and go work at a medical mission in a developing country like Haiti (if they'd have her); her skills would be much better served there, plus there'd be a lot less paper work. Of course, she'd be working for free and for charity, not $50 a shot (which I find shocking from a socialized medicine perspective).

Also, $500USD for asthma medication??? That's crazy. I have severe asthma and have never come close to spending that much on a single inhaler, that's inhuman! I'm living in a developing country, a Ventolin inhaler here (branded made in France) costs 50 cents.

Actually, I can name two right now (inhaled steroids) that are over $500 per inhaler.Xolair ($500 - $2000 per month), and Advair 50/500 ($400 per month [2014, it's more now])

She should retire from the US and go work at a medical mission in a developing country like Haiti (if they'd have her); her skills would be much better served there, plus there'd be a lot less paper work. Of course, she'd be working for free and for charity, not $50 a shot (which I find shocking from a socialized medicine perspective).

Also, $500USD for asthma medication??? That's crazy. I have severe asthma and have never come close to spending that much on a single inhaler, that's inhuman! I'm living in a developing country, a Ventolin inhaler here (branded made in France) costs 50 cents.

Actually, I can name two right now (inhaled steroids) that are over $500 per inhaler.Xolair ($500 - $2000 per month), and Advair 50/500 ($400 per month [2014, it's more now])

A lot of what I learned in medical school has been superseded, and I only qualified 11 years ago. It's not just medical knowledge though, it's processes, skills, ethics, working practices. The pace of change is rapid, and rightly so - we learn new stuff, and better ways of doing things, and we have to keep up. Science, right?

I question whether someone can even be a competent doctor today without computer skills. You don't need to be a sysadmin but you do need to be able to record, access and process information.

In fact, information/knowledge isn't what doctors have that makes them useful any more, in contrast with the good ol' days. You can google pretty much any medical fact you want to. It's the interpretation and application of that knowledge (and separating out the nonsense) that makes us somewhat worth having around, at least for the time being until machines make us redundant.

If your processes are from the 1960s and your way of keeping up is paper-only, I can't imagine how you can have sufficient up-to-date knowledge to do a good job as a clinician.

you do know there are ways to acquire knowledge without the use of the holy internet right?

Feel free to go right ahead and explain how a completely IT-incompetent doctor keeps appropriately up to date today. Once they've followed your method, perhaps you'd like your family to be treated by them?